opinionBy Bright B. Drah
e HIV/AIDS epidemic continues to have a multi-dimensional devastating impact worldwide, particularly in sub-Saharan Africa. Whilst efforts have been focused on preventing incident (new infections), the care for those who have already been infected is emerging as a major issue in the HIV/AIDS discourse.
Religious groups or faith-based organisations (FBOs) and their leaders continue to play an important role in educating communities and in providing care and support for those infected.
However, we need to critically examine the roles played by these groups and the challenges confronting them in order to inform their HIV/AIDS activities.
Before we look at the role of the FBOs, it is important that we appreciate the harm that the pandemic carries in its entrails. This overview of the pandemic within the global and the Ghanaian context will also enable us appreciate the context within which religious leaders strive to combat the spread of the pandemic and also to alleviate its devastating impact.
Why the youth?
The importance of the youth has often been expressed in (socio-economic) terms. In Ghana, it is estimated that 720,000 people who contribute to the socio-economic development of the country are living with HIV/AIDS. But the importance of the youth transcends socio-economic parameters.
The youth are a group that no family, community or society can ignore. They are guided and protected for many reasons, but mainly for their potential. Youth are an embodiment of our dreams, our values, our history and our aspirations. We hope that the youth will achieve the things that we have desired, but have sometimes failed abysmally to achieve.
We also do hope that they will correct some of the things we did not do right. Indeed, the youth are our future; like the nation, religious groups have no with future without the youth. Unfortunately, the future of youth worldwide, and those of Ghana in particular, are threatened by a disease that is not discriminatory.
The growing scourge It is estimated that 720,000 Ghanaians between 15 and 49 years old (3.6 per cent of the adult population) were living with HIV/AIDS as at the end of 2003 (NACP, 2004). This estimate represents an increase in HIV prevalence from 2.3 per cent in 2002 to 3.6 per cent in 2003. Notably, this increase is even more marked in certain regions of Ghana.
For example, Agomanya, a (semi-urban) community in the Manya Krobo District of the Eastern Region showed a decline of 3.2per cent between 2001 and 2002, yet peaked at 9.2 per cent in 2003. While there are likely a number of reasons that would explain this increase, this rise is a source of great concern. Nationally, there was a slight decline in HIV prevalence for those between ages 15 and 24 between 2002 and 2003 (i.e., 3.4 per cent to 3.0 per cent).
In certain quarters, this decline has been viewed with optimism and has also been attributed to the effectiveness of programmes carried out thus far by various HIV/AIDS organisations and communities in the country.
Whilst this may be the case, we must view these statistics with caution. For instance, it has been observed (The Economist, January 17th - 23rd 2004) that apart from methodological challenges, such declines could be due to a rise in deaths from AIDS. The latter observation is worth noting particularly in the context of Ghana's chronically limited HIV/AIDS related medical services.
While prevalence is low, compared to countries to our East (Togo) and West (Cote De Ivoire), where prevalence is between 8 and 16per cent, or countries in the South where prevalence exceeds 25 per cent, the potential is there for an enormous, generalised, epidemic. We must view these increases with concern. Immediate measures must be taken to reverse the general trend of HIV infections; indeed, a rise in prevalence is a threat not only to the lives of individuals and families, but also to the socio-economic and total development of Ghana.
Youth and HIV/AIDS
Youth -people in the prime of their lives- are the group most affected by HIV/AIDS. Indeed, some die before they ever reach adulthood. The youth are generally vulnerable as depicted in the social reality in which they find themselves. A number of complex and interacting biomedical and socio-cultural factors contribute to the vulnerability of the youth in general, and of the female youth in particular.
For instance, lack of education, poverty, disease, lack of jobs, age differences between partners, genital damage from sexual violence, etc. affect female youth more than male youth. Since HIV infection levels increase with age, young women are more vulnerable than their older male partners.
Globally, females are disproportionately affected by HIV especially those younger than 24 years old.
In sub-Saharan Africa, 58 per cent of 29.4 million People Living With AIDS (PLWA) are women. Thirteen women are affected for every 10 men. Clinically, female youth (especially the teenagers) are more vulnerable than their male counterparts to acquiring HIV infection because they are biologically more susceptible. Further, they are disproportionately affected by sexually transmitted diseases (STDs) and other common infections than are males.
Women are more likely to be abused and less likely to have access to information.
Socio-cultural practices such as genital mutilation and permissive sexual traditions, which contribute to the spread of HIV affect women most. Where sexual violence exists, the victims by and large are women.
All these factors combined present a formidable challenge for efforts meant to fight the HIV/AIDS pandemic. For example, sexual violence is making it difficult to find a suitable effective strategy for women. Even though abstinence is the ultimate preventive method, it is not an appropriate response in a context where sexual violence occurs - i.e., where females' engagement in sex is not by choice but rather by force.
How can females who are vulnerable to violence protect themselves?
Clearly, abstinence is not the answer. Insisting on condom use is also clearly not a realistic option for women in this context.
There are aspects of religion and culture that make female youth more vulnerable. For example, there is a culture of silence, which is part of the socialisation process that tends to affect females negatively and much more so when it comes to HIV/AIDS communication and education.
Among the Krobos, for example, the girl-child is trained to be quiet and respectful, and this is reinforced and internalised by important cultural practices like the "Dipo" rites of passage during which they are trained inter alia: "What the eyes see, the mouth doesn't speak". In this case, culprits of sexual violence, to an extent, reinforce that culture of silence when they 'ask' their victims not to say a word about their ordeal.
Impact of HIV/AIDS on the youth (Anecdotal evidence)
The statistics of HIV/AIDS incites fear and gloom. However, to depict the impact of the pandemic, I would like to look beyond the quantification. Here, I would like to rely on anecdotal evidence that I have gathered from communities I have worked in, from the Krobos of Ghana to the Zulus of South Africa.
Young men and women in general are affected by HIV/AIDS in one way or another. If they are not infected by the virus, they know someone who is or are affected by the consequences of having a family member who is infected. The anecdotal evidence indicates that the pandemic has ravaged families and communities and rendered many individuals hopeless.
Families are devastated and leaving children and/or older women with the many responsibilities of caring for even younger siblings or terminally ill adults.
HIV/AIDS has caused families to disintegrate (e.g., through divorce, separation, neglect or death). Very young children have to struggle to find food for their dying relatives. The same hungry little ones have to live with the trauma of seeing their older relatives suffer to death. I have observed parents turn against their children, and siblings against their parents and/or other siblings. People have been rejected by others who have once loved and cherished them as their own. Social cohesion, which is the basis for the provision of care and support to members of a particular social group, has been nearly non-extant especially in the case of those in need of HIV/AIDS support. Due to HIV/AIDS, money and treasures stored by families for decades- or even centuries - which could have been used to provide for basic needs (e.g., school fees, food) have been spent on seeking health care for People Living With AIDS (PLWA).
Families that were economically independent have been chronically impoverished as a result of HIV/AIDS. Youth have not been able to learn trades or pursue even basic education because monies that would have been spent on their careers are being used to cater for relatives who have HIV/AIDS. Some of the youth have to stay at home and take care of their relatives. In fact, sometimes, the youth themselves have ended their lives because they were HIV infected and could do nothing other than stay home and take care of themselves.
As mentioned earlier, most families look to their children with hope, particularly because they have invested time and money in them with the hope that they will eventually support the family. When these youth become infected with HIV, rather than providing for their families, they become even more dependent as their illness compels them to abandon employment and return to their township or village. They say - "they come and die". With sickness and death, the poverty and insecurity of their families increase and their sense of hopelessness aggravated.
Clearly then, being HIV infected does not begin and end with any individual. Some of the young people themselves have younger children who they leave behind upon death. These innocent children become secondary victims of HIV/AIDS.
In the midst of all these agonies, many youth do not know their HIV-status and may be living either in fear or in ignorance or even in uncertainty, unsure of what's next. This condition is by itself psychologically damaging and can turn an otherwise vibrant group of people into a group without hope.
Support from religious groups Treatment for HIV and related opportunistic infections is, for the most part, geographically and economically inaccessible to the poorest of the poor in resource-constrained countries who are the most affected by HIV/AIDS.
Indeed, fewer than 6 per cent of those who need Highly Active Antiretroviral Therapy (HAART) in Africa receive it. The picture is not different from Ghana in spite of recent efforts to increase HAART accessibility. Even if pharmaceutical and biomedical solutions were available, PLWA would still need other support services in the form of psycho-social support, including spiritual and/or religious comfort, good social relations, counselling and living with dignity -that is, not being stigmatised and not being treated as less human.
Religious bodies have a crucial role to play in this area. Initiatives of religious groups for the youth can address issues of loneliness, hopelessness, lifelessness, emptiness and worthlessness, all of which appear to be associated with HIV/AIDS.
Current programmes by religious groups The above overview shows the enormity of the task that confronts anti-HIV/AIDS groups in general and the FBOs in particular. It is against that backdrop that the FBOs have tried to contribute to the reduction of new infections and also help alleviate the pain that PLWA and their families go through. Traditionally, FBOs in general, have focused on programmes that promote abstinence and faithfulness among married partners. Condom remains more of a taboo to most FBOs. Abstinence and virginity programmes are the most popular among FBOs because they are largely in tune with their teachings and principles about life. For example, some religious organisations promote 'virginity clubs' with the ultimate aim of keeping young boys and girls from engaging in pre-marital sex. Indeed, projects like virginity clubs are very laudable, but they must also be considered as ideal.
That is, seeking to adopt 'the ultimate strategy' under very challenging circumstances and among a sub-population that is very mobile, exuberant, restless, potent yet volatile and vulnerable.
Thus, the promotion of virginity and the deferment of sexual debut could be very daunting tasks and evidence show these programmes are not particularly effective.